CMS Touts Fraud Prevention System: Beware. Be Prepared

Dr. Shantanu Agrawal, Deputy Administrator and Director, Center for Program Integrity at the Centers for Medicare & Medicaid Services (CMS) was in the news again. Last week, Dr. Agrawal and colleagues Raymond Wedgeworth and Kelly D. Bowman posted a blog on the CMS blog site, touting the efficacy of its Fraud Prevention System (FPS).

“Since its June 2011 inception, the FPS has identified significant savings by running sophisticated analytics on 4.5 million Medicare claims on a daily basis, prior to payment,” Dr. Agrawal and his colleagues wrote. “Year after year, the FPS has continued to improve its ability to identify or prevent fraud.”

Dr. Agrawal continued by saying that “since the beginning of the program, over $1.5 billion in inappropriate payments has been identified by the system through new leads or contributions to existing investigations.”

Of particular interest was Dr. Agrawal’s reporting on how CMS views a return on investment (ROI) for their efforts by adding “Also, in 2015, the CMS marked its first-ever national return-on-investment of $11.60 for every dollar the federal government spends on this program integrity system.”